Proximal Adaptations in Chronic Ankle Instability: Systematic Review and Meta-analysis

Abstract

Introduction Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on proximal adaptations of the trunk, hip, thigh, and knee for neuromuscular and biomechanical outcomes during strength, balance, jumping, and gait among CAI patients. The purpose of this systematic review and meta-analysis was to synthesize trunk, hip, thigh and knee neuromuscular and biomechanical outcome measures during functional assessments when comparing CAI to healthy groups. Methods Cumulative Index of Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online with PubMed databases were searched on June 3, 2019. Studies comparing outcomes at the trunk, hip, thigh, or knee regardless of assessment type in CAI versus healthy groups were considered for inclusion. Assessment categories were used to differentiate adaptations by assessment type after inclusion. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Database scoring criteria. Data pertaining to study methodology and primary proximal adaptation outcomes were extracted. Separate random effects meta-analyses were performed for consistently reported outcome measures. Results Pooled estimates reflected that CAI patients had decreased triplanar isometric hip strength outcomes (P < 0.001, effect size range: 0.52–0.93). Knee kinematics did not differ from healthy groups during dynamic balance testing (P = 0.26). Few studies found CAI patients have altered knee kinematics during jumping tasks. The remaining findings were isolated to individual studies and thus inconclusive. Conclusions The CAI groups demonstrated triplanar hip strength deficits and altered knee flexion angles during jumping assessments. Clinicians should consider proximal evaluations and interventions for CAI patients.

Corticomotor excitability of the gluteus maximus in individuals with chronic ankle instability: A pilot study

“…Thus, hip joint impairments identified in CAI populations might not be derived from changes in the motor cortex and descending corticospinal tracts. Since individuals with CAI have previously exhibited impaired hip muscular strength and activation, 5,15,16 we expected the CAI group to have a higher AMT, representing a lower corticomotor excitability, compared to COP and CON. While our findings were unexpected, we must note that GM AMT is often a difficult measure to gather.…”

“…15 More recently, delayed gluteal muscle activation, altered hip kinematics, and reduced isometric hip strength have been demonstrated in individuals with CAI. 16 Reduced isometric hip strength was also associated with reduced balance performance among individuals with CAI. 17 These global changes along with the host of aforementioned sensorimotor insufficiencies affecting this population provide evidence that impairments may be driven by changes in the central nervous system.…”

“…These impairments were originally discovered in a study that reported chronic ankle and foot pathologies (including CAI) were associated with ipsilateral hip abductor and adductor weakness 15 . More recently, delayed gluteal muscle activation, altered hip kinematics, and reduced isometric hip strength have been demonstrated in individuals with CAI 16 . Reduced isometric hip strength was also associated with reduced balance performance among individuals with CAI 17 .…”

Barriers and Facilitators to Clinical Utilization of Contemporary Research Findings in Ankle Instability Rehabilitation among Healthcare Professionals in Anambra State, Nigeria

“…CAI is thought to be the result of deficits in neural proprioception, reflexes, muscular reaction time, muscular strength, power, endurance, and mechanical mechanisms (ligamentous laxity) [8]. Chronic ankle instability can be functional or mechanical in nature [9,10]. Functional instability depends on the patient-generated reports or complaints that could be accompanied by clinical laxity while mechanical instability can be identified by physical examination [9].…”

Current trends in the biokinetic analysis of the foot and ankle

“…Other authors have also demonstrated the influence of the ankle dorsiflexion range of motion in femoral medialization, a movement dysfunction often referred as "dynamic valgus". The proximal chain can influence and be influenced by distal changes and interfere on the loading of joints and segments as a whole (29) (Figure 6).…”